1 reason the procedure has fallen out of favor is that it actually contributes to worse tearing than might occur naturally during childbirth. As many as 79 percent of women who deliver vaginally will experience some vaginal tearing during childbirth.
An episiotomy is usually not needed in a healthy birth without any complications. Experts and health organizations such as ACOG and the World Health Organization (WHO) only recommend an episiotomy if it is medically necessary.
An episiotomy makes the opening of your vagina wider, which allows your baby to come through more easily. Sometimes your perineum will tear naturally as your baby comes out. This is called perineal tear (or laceration). Healthcare providers don't recommend routine episiotomies and prefer that you tear naturally.
However, episiotomy became increasingly controversial as growing evidence demonstrated that its routine use caused worse perineal and vaginal trauma for women [3, 4]. Clinical guidance issued by professional bodies across the globe now mandates the use of episiotomy only in cases of direct clinical need [5–7].
Long-term effects of episiotomies can include: Chronic pain and infections. A small linear scar. Anorectal dysfunction.
Episiotomy risks
Sometimes the incision is more extensive than a natural tear would have been. Infection is possible. For some, an episiotomy causes pain during sex in the months after delivery. A midline episiotomy puts you at risk of fourth-degree vaginal tearing.
“Then you're condemning some women to an episiotomy who might've had a lesser tear or no tear at all if left to their own devices,” she said. Women have the right to refuse any procedure in the hospital, including an episiotomy, but they're not always aware that the doctor is about to perform one.
Generally speaking though, a previous episiotomy doesn't guarantee needing a repeat one for future births. There are many options to help reduce the risk of tearing and/or episiotomy. It's also important to be sure your maternity care provider is up to date and following current guidelines regarding episiotomies.
indicated the possible drawbacks of routine episiotomy to be the extension of the episiotomy incision, unsuitable anatomic outcomes, increased blood loss and hematoma formation, pain, inflammation, infection and dehiscence within the episiotomy region, sexual dysfunction, and increased costs (Table 1).
Your midwife or obstetrician may do an episiotomy to try to prevent a third or fourth-degree tear if: you're likely to tear.
The rate of episiotomy was determined as 93.3% in primipara women and as 30.2% in multipara women.
Due to the amount of pressure caused by your baby's head on your perineum, it is unlikely that you will feel any tearing. But everyone's birth is different and some women may find that they feel a lot of stinging, especially as the head is crowning (when your baby's head can be seen coming out of the birth canal).
Reasons some women still get episiotomies
If the baby's heart rate drops during pushing, the doctor might recommend episiotomy to speed up the delivery. Another situation is if the baby needs more space, such as when the shoulders are wider than the head and the baby becomes stuck.
The Risks of Episiotomies & Natural Tearing
Women very commonly need stitches to repair tearing, severe tearing can be extremely painful initially and result in long-term problems like incontinence, pain during sexual intercourse, and ongoing pain.
Will the wound be re-stitched? If there is an infection the wound will not be re-stitched. This is because it can trap infection inside, and infected tissues may not stitch back together well. If there is no infection, or the infection has been treated, the wound may be re-stitched in theatre.
Around 1 in 4 (23%) mothers had an episiotomy, noting that women could be recorded as having both an episiotomy and some degree of laceration.
natural tearing. Research has shown that moms seem to do better without an episiotomy, with less risk of infection, blood loss (though there is still risk of blood loss and infection with natural tears), perineal pain and incontinence as well as faster healing.
Following an expected course of healing, this pain should continue to improve, resolving in most by the 8th week of the postpartum period. But pain can stick around for 18 months or longer in up to 10% of those who had scarring after a vaginal delivery.
The husband stitch is the term for an extra stitch that some women say they have received during the repair of an episiotomy or vaginal tear. This procedure takes place after delivery to decrease the size of a woman's vaginal opening. It is an outdated procedure that has no approved medical use or benefit.
Try to stay in an upright position, and let gravity help. Choosing a different position from lying on your back, such as kneeling on all fours or lying on your side, can help you give birth without the need for an episiotomy. Some deep squatting positions, however, can increase the likelihood of tearing.
The incision can be performed on either side and is generally 3-4 cm in length. The anatomic structures involved in a mediolateral episiotomy include the vaginal epithelium, transverse perineal muscle, bulbocavernosus muscle, and perineal skin.
Most women say they have less pain or discomfort after the first week. Most episiotomies heal in 3 weeks.
In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.